Prevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorOLIVEIRA, J. F.
dc.contributor.authorMOURA, E. G. H.
dc.contributor.authorBERNARDO, W. M.
dc.contributor.authorIDE, E.
dc.contributor.authorCHENG, S.
dc.contributor.authorSULBARAN, M.
dc.contributor.authorSANTOS, C. M. L.
dc.contributor.authorSAKAI, P.
dc.date.accessioned2016-10-17T16:37:57Z
dc.date.available2016-10-17T16:37:57Z
dc.date.issued2016
dc.description.abstractEndoscopic submucosal dissection (ESD) of extensive superficial cancers of the esophagus may progress with high rates of postoperative stenosis, resulting in significantly decreased quality of life. Several therapies are performed to prevent this, but have not yet been compared in a systematic review. A systematic review of the literature and meta-analysis were performed using the MEDLINE, Embase, Cochrane, LILACS, Scopus, and CINAHL databases. Clinical trials and observational studies were searched from March 2014 to February 2015. Search terms included: endoscopy, ESD, esophageal stenosis, and esophageal stricture. Three retrospective and four prospective (three randomized) cohort studies were selected and involved 249 patients with superficial esophageal neoplasia who underwent ESD, at least two-thirds of the circumference. We grouped trials comparing different techniques to prevent esophagus stenosis post-ESD. We conducted different meta-analyses on randomized clinical trials (RCT), non-RCT, and global analysis. In RCT (three studies, n = 85), the preventive therapy decreased the risk of stenosis (risk difference = -0.36, 95 % CI -0.55 to -0.18, P = 0.0001). Two studies (one randomized and one non-randomized, n = 55) showed that preventative therapy lowered the average number of endoscopy dilatations (mean difference = -8.57, 95 % CI -13.88 to -3.25, P < 0.002). There were no significant differences in the three RCT studies (n = 85) in complication rates between patients with preventative therapy and those without (risk difference = 0.02, 95 % CI -0.09 to 0.14, P = 0.68). The use of preventive therapy after extensive ESD of the esophagus reduces the risk of stenosis and the number of endoscopic dilatations for resolution of stenosis without increasing the number of complications.
dc.description.indexMEDLINE
dc.identifier.citationSURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, v.30, n.7, p.2779-2791, 2016
dc.identifier.doi10.1007/s00464-015-4551-9
dc.identifier.eissn1432-2218
dc.identifier.issn0930-2794
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/16201
dc.language.isoeng
dc.publisherSPRINGER
dc.relation.ispartofSurgical Endoscopy and Other Interventional Techniques
dc.rightsrestrictedAccess
dc.rights.holderCopyright SPRINGER
dc.subjectEndoscopy submucosal dissection
dc.subjectESD
dc.subjectEsophageal stenosis
dc.subjectEsophageal stricture
dc.subjectMeta-analysis
dc.subjectSystematic review
dc.subject.othersquamous-cell carcinoma
dc.subject.otherballoon dilatation
dc.subject.othermucosal resection
dc.subject.othercancer
dc.subject.otherinjection
dc.subject.othertriamcinolone
dc.subject.otherdilation
dc.subject.otherstenosis
dc.subject.otherefficacy
dc.subject.otherlesions
dc.subject.wosSurgery
dc.titlePrevention of esophageal stricture after endoscopic submucosal dissection: a systematic review and meta-analysis
dc.typearticle
dc.type.categoryreview
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalBERNARDO, W. M.:Brazilian Med Assoc AMB, Sao Paulo, Brazil; Med Fed Council CFM, Sao Paulo, Brazil
hcfmusp.citation.scopus37
hcfmusp.contributor.author-fmusphcJOEL FERNANDEZ DE OLIVEIRA
hcfmusp.contributor.author-fmusphcEDUARDO GUIMARAES HOURNEAUX DE MOURA
hcfmusp.contributor.author-fmusphcEDSON IDE
hcfmusp.contributor.author-fmusphcSPENCER CHENG
hcfmusp.contributor.author-fmusphcMARIANNY NAZARETH SULBARAN NAVA
hcfmusp.contributor.author-fmusphcCINTIA MORAIS LIMA DOS SANTOS LATORRE
hcfmusp.contributor.author-fmusphcPAULO SAKAI
hcfmusp.description.beginpage2779
hcfmusp.description.endpage2791
hcfmusp.description.issue7
hcfmusp.description.volume30
hcfmusp.origemWOS
hcfmusp.origem.pubmed26487197
hcfmusp.origem.scopus2-s2.0-84944937582
hcfmusp.origem.wosWOS:000378791200019
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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